染色淋巴结示踪剂在甲状腺癌手术中的应用选择分析

【摘要】目的探讨染色淋巴结示踪剂在甲状腺癌手术中甲状旁腺保护、淋巴结清扫的应用选择。方法选择甲状腺乳头状癌cNI患者86例，分成亚甲蓝组（A组），纳米碳组（B组），其中纳米碳组按注射时间不同分成二个亚组（B1组，B2纽），观察甲状旁腺保护及淋巴结示踪结果。结果B2组甲状旁腺检出高、甲状旁腺误切率低于A、B1组；B2组检获的淋巴结枚数（包括微小淋巴结〈2mm）、微小淋巴结（〈2mm）肿瘤转移枚数显著高于A、B1组，但去除微小淋巴结（〈2mm）肿瘤转移枚数，转移淋巴结染色率B2组与A组及B1组组间无差异。结论亚甲蓝注射液与纳米碳混悬注射液在甲状腺肿瘤术中应用均能更好识别并有效保护甲状旁腺；在甲状腺癌手术中均可满足临床淋巴结清扫需要。亚甲蓝注射液因其价廉更易被接受与推广；纳米碳混悬注射液在甲状腺癌淋巴结清扫追求彻底与相对精准方面有优势，但需术前注射并价格昂贵。

Objective To investigate the application of the tracer agent of lymph nodes in the protection of parathyroid gland and lymph node dissection in thyroid diseases. Methods A total of 86 patients with papillary thyroid carcinoma （ cN1 ） were selected. The patients were divided into two groups , the methylene blue （ group A ） , and the nano-carbon （ group B ） .The later were divided into two subgroups （ group B1, group B2 ） , according to the phase of injection. Results Higher parathyroid detection rate and lower inadvertent parathyroidectomy rate were observed in group B2, compared with group A and group B 1; The total number of dissected lymph node in group B2 was much more than group A, and groupB 1, （ including micro-lymph node 〈2mm ） , The number of metastatic micro-lymph node tumor was also significantly higher than that in group A, and group B 1, There is no difference between group B2 and group A , B 1 in the staining rate of metastatic lymph nodes. Conclusion The methylene blue and the nano carbon can also identify and protect the parathyroid gland in the operation of thyroid carcinoma. Methylene blue is more acceptable and esily promoted for its low cost, The nano carbon has some advantages in the lymph node dissection in thyroid carcinoma, but it should be used pre-operatively and has some disadvantages in price.